Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Sunday, March 05, 2006

The Nanny State?

As our millions of faithful readers know, for better and for worse, I am on crusading public health lawyer John Banzhaf's mailing list. Banzhaf, having wacked the tobacco companies to some good effect, is now taking on the soda mongers. He's definitely right on the science, and I'm with him every step of the way when it comes to restricting marketing and advertsing of harmful products, particularly to children, but we start to part company a bit when we get into the territory of restricting behavior by adults that doesn't directly harm other people.

This came up in the context of his crusade to ban smoking out of doors, essentially on the grounds that it sets a bad example for children. This argument starts to cross the line into thought policing, or at least it triggers the proximity detector. Many people will say that it's up to parents, not the government, to decide what moral influences are appropriate for kids. Here's from Banzhaf's latest:

Several reports about to be published in major scientific journals will provide very strong additional evidence in massive fat class-action law suits about to be filled [sic] in Massachusetts and other states which will target soft drink bottlers, and potentially involve school boards and individual school board members.

It's already known that one of every five calories in the American diet is liquid, and that the nation's single biggest "food" is soda. The new studies are expected to show for the first time not only that soft drinks are closely associated with obesity, but that they along with other factors are a major cause of obesity. Indeed, the studies suggest that sugary soft drinks may be the leading cause of the current epidemic of obesity.

"Among the many causes of this sudden explosion of obesity and obesity-related diseases -- possibly including genetics, lack of sufficient exercise, fast food outlets, increased portion size, attitude changes, etc. -- soda is probably the one which can be significantly changed most quickly and easily," says public interest law professor John Banzhaf who is leading the battle to use legal action as a weapon against the problem of obesity.

"That's why law suits and other legal actions directed against sugary soft drinks may be far more effective than expensive public education campaigns -- which have to compete against billions of dollars spent each year advertising soda -- or simply complaining about the lack of personal or parental responsibility."

When the Associated Press suggests in an article that these new studies could lead to "higher taxes on soda, restrictions on how and where it is sold -- maybe even a surgeon general's warning on labels," it's clear that the idea of using legal action to target obesity has become mainstream, suggests Banzhaf.

I go along with his suing soda companies for their "kickbacks for vending machine space" contracts with school boards. Taxes on soda that equal the negative externalities -- the costs to society of obesity and diabetes caused by sugary soft drinks -- are more than defensible under classic economic theory. (Note, however, that the theory supports taxes equal only to the harm to people other than the buyer, assuming the buyer is fully informed and is making a free decision to accept the risk. Such expenses might include loss of support to dependents of people disabled by diabetes, snd costs to the public sector for medical expenses.) A warning label is also fully defensible.

Restrictions on how and where soda is sold, however, are another matter. Although Banzhaf seems to pass it over as a comparatively minor step, in my view it is really the largest, and most questionable one. This represents a restriction on people's liberty to do what they freely choose, that is for willing sellers and willing buyers to engage in a transaction. Assuming the externalities tax and the warning label are in place, there is no evident justification for such a step.

I also am an opponent of prohibition of drugs of abuse, for the most part. (I'm a little shaky on meth.) That subject is a bit more complex, but the same arguments enter into it. Of course, most people who would oppose restrictions on soda sales are probably in favor of the prohibition of heroin and cocaine, and even marijuana, but I'm just thinking for myself here. I believe that much of the public resents what they see as "Nanny State" restrictions on their behavior, such as seat belt and helmet laws, and we need to respect these sentiments. Liberty does count in the balance.